The Role of Aggressive Surgery in Advanced Epithelial Ovarian Cancer

Objective: To assess the role of debulking surgery as a therapeutic option for improving survival in advanced ovarian cancer.Methods: This was a retrospective cohort trial addressing the survival benefit of two different philosophies of surgery at two different cancer centres in Ontario. To be included in the study, a woman with advanced epithelial ovarian cancer had to have primary treatment with surgery between 1983 and 1992 at either Hospital A (aggressive intent) or Hospital S (standard of care). A gynaecologic oncologist had to be present for the surgery.Results: Sixty-eight patients at Hospital A and 56 patients at Hospital S met the inclusion criteria. The mean age in years ± SD was 63 ± 10 at Hospital A and 61 ± 10 at Hospital S. In Hospital A, 91 percent of women were optimally debulked whereas only 43 percent were optimally debulked in Hospital S. A log rank statistic showed overall survival was better at Hospital S (p = 0.02), but using an adjusted Cox PH model, there was no difference in survival between the two Hospitals (HR=0.909, 95% CI 0.58–1.42).Conclusion: Aggressive surgery did not provide a survival advantage when compared to the ‘organ sparing’ surgery performed by gynaecologic oncologists.